Healthcare Provider Details

I. General information

NPI: 1528601580
Provider Name (Legal Business Name): LAUREN ASHLEY RYDELEK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 PARK AVE STE 7
SCOTCH PLAINS NJ
07076-1768
US

IV. Provider business mailing address

551 PARK AVE STE 7
SCOTCH PLAINS NJ
07076-1768
US

V. Phone/Fax

Practice location:
  • Phone: 908-591-4392
  • Fax:
Mailing address:
  • Phone: 908-322-9623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00673800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: